Although the Centers for Medicare and Medicaid Services (CMS) released the final rule under the Medicare Access and CHIP Reauthorization Act (MACRA) back in October, it’s still looking for feedback in certain areas affected by the regulation. You can still provide feedback and suggestions, but your time if running out. You must submit your comments by 5 p.m. on Dec. 19.

In particular, CMS would like you to speak out about the following topics under each of the two Quality Payment Program categories. The agency will then take any comments you submit into consideration for future rulemakings.

For the Merit-Based Incentive Payment System (MIPS)

1. Virtual Groups — CMS plans to implement virtual groups for the 2018 performance period. These allow small and solo practices to pool their resources for quality reporting and improvement. Specifically, the agency would like you to comment about factors it should consider when implementing these groups, including:

• • Establishing minimum standards for members of the virtual groups.
  • How the groups could use their data for analytics.
  • Whether the initial implementation should be handled as a pilot study.
  • Requirements that would use the virtual groups to enhance health outcomes and goals.
  • Use of a group identifier.

2. MIPS Scoring — There are several items on which CMS is seeking your opinion under this subject:

• • Approaches for non-outcome measures that cannot be scored — these are those measures that are below the case minimum, lack a benchmark or don’t meet data completeness standards.
  • Alternative approaches to establishing measure benchmarks and handling topped out measures. Remember that a measure is topped out if performance on the measure is so high and unvarying that the agency can no longer make meaningful distinctions and improvement in performance.
  • Stratifying measure benchmarks based on practice size for the 2018 performance period.

3. Non-Patient-Facing Clinicians — These are those practitioners who do not have face-to-face encounters with patients, such as pathologists and radiologists. CMS is looking for alternate terminology that it can use for these providers and criteria for designating a group as non-patient facing.
4. Low-Volume Threshold — For the 2017 performance period, CMS defined the low-volume threshold to exclude clinicians with Medicare Part B allowed charges less than or equal to $30,000 or 100 or fewer patients. The agency wants to know how you feel these clinicians could opt-in and be subject to the MIPS payment adjustment.
5. Groups — CMS wants your input regarding how it can use an identifier so groups with both eligible and non-eligible clinicians can participate. This is important because the agency determines individual eligibility before groups identify themselves and report data.
6. Quality Performance Category — CMS removed the cross-cutting measures — which focus on population health improvement — from the final rule and is now seeking comments about the overall requirements for these measures in future performance periods.
7. Advancing Care Information (ACI) Performance Category — The agency is looking for your feedback about several items under this topic:

• • The improvement activities bonus
  • Approaches for how to incorporate non-outcome measures (those that can’t be scored because the measures are below the case minimum, lack a benchmark or don’t meet data completeness standards).
  • Alternate ideas for establishing measure benchmarks and handling topped out measures.
  • Stratifying measure benchmarks by practice size in Year 2 of the program.

Under the Advanced Alternative Payment Model (APMs):

1. Other Payer Advanced APMs — CMS is looking for ideas regarding the overall design of Other Payer Advanced APMs by non-Medicare payers for the 2019 performance period and later.
2. Nominal Standards — The agency is seeking comments about the amount and structure of the revenue-based nominal amount standard for the 2019 performance period and later, specifically about the following:

• • Establishing the revenue-based standard for 2019 and later as high as 15% of revenue; or
  • Setting the revenue-based standard at 10% as long as the risk is at least equal to 1.5% of expected expenditures for which an APM Entity is responsible.

3. All-Payer Combination Option — CMS is considering — and would like your feedback about — creating a separate pathway to determine whether Medicaid APMs are Other Payer Advanced APMs for the All-Payer Combination Option.

You can submit your comments online at www.regulations.gov. Don’t forget, they have to be in by 5 p.m. on Dec. 19.